Shane Brykailo Brykailo,

Debra Jizi

U-Write 1104

3/29/17

Annotative Biblography

Fulco, Carolyn, Catherine T. Liverman, National Institute on Drug Abuse, and Institute of

Medicine. "The Development of Medications for the Treatment of Opiate and Cocaine

Addictions: Issues for the Government and Private Sector" at NAP.edu." National Academies

Press: OpenBook. National Academy Press, n.d. Web. 29 Mar. 2017.

This source is a culmination of research conducted over the last 30 years. After the

government realized the severity of an opiate epidemic, they created the National Institute on

Drug Abuse and commissioned the Institute of Medicine to find solutions. After successfully

creating naltrexone (Narcan) and levoaplhaacetylmethadol (LAAM) to help with treatment.

These drugs were synthesized in the 1960s and 1970s, since then there has been no approved

treatments. This book follows the creation of these treatments, and the research and statistics

surrounding the opiate crisis in America. In addition, this book highlights how drug addiction has

become a route for spreading diseases like the HIV virus, lead to an increase in violent crime,

and cause issues with fetal development of the next generation.

Reading this source has provided me with a wealth of background knowledge on the

history of opiate addiction and treatment in America. Relating to my inquiry about the treatment

of opiate addiction, this source has information about the first efforts to treat this crisis. Im glad

that I found a source that was created by medical organization like the Institute of Medicine. The

information is unbiased and focuses on the facts of the situation. There is an incredible amount of
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research in this one source, but luckily the section on treatments includes details on treatment

settings, effectiveness, and even financial statistics that I can compare to information today. This

source is great for acclimating myself to the issue.

Because of the official government organization that created this paper, this source

included sources on where they drew their research from. In addition, The Institute of Medicine

and The National Institute of Drug Abuse included first-hand accounts from their researcher that

adds a firsthand perspective to some aspects of the book. The National Institute of Drug Abuse

was created by the American government to find solutions to this epidemic. With the

professional origins of this source, I trust its credibility.

Deck, Dennis D., Wyndy L. Wiitala, and Katherine E. Laws. "Medicaid Coverage and

Access to Publicly Funded Opiate Treatment." The Journal of Behavioral Health Services &

Research 33.3 (2006): 324-34. Web.

This source focuses on the ever-changing dynamic between government funding and

effectiveness of healthcare programs. Following a study conducted in Oregon, researchers

strived to discover how Medicaid budget cuts would affect the success rate of opiate

addiction treatment. Prior to the unprecedented budget deficit that occurred in 2002, Oregon

was one of only 25 states whose Medicare programs included access to substance abuse

treatment. Until the funding for the program was cut, the benefits from Medicare led to a

sharp increase in the participation in methadone clinics. Compared to the amount of enrolled
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patient in methadone treatment during 2002, new admissions were only 26% of the number

of patients from the previous year.

The data in this source confirms an important distinction I wanted to make during this

inquiry paper. The success rate of addiction treatments is directly related to availability and

quality of the treatment centers. Many people going through substance abuse do not have

access to private health insurance, making treatment incredibly expensive. In addition,

people participating in treatments like methadone clinics are more likely to cure their

addictions over a long period of time. Providing the proper medical assistance is crucial in

helping rehabilitate these people, and when programs like Medicaid are well funded it allows

many more people to get the help they need.

This article is published in The Journal of Behavioral Health Services and Research,

which is an official publication of the National Council for Behavioral Health. This

organization has collaborated with over 2,800 organizations all with the goal of improving

mental health for those who need it. They have trained more than 600,000 individuals to help

connect members of their communities to mental health and addiction clinics. The editor-in-

chief of this journal, Bruce Lubotsky Levin holds degrees in the Master of Public Health and

Doctor of Public Health. In 2001, Bruce received the Harold C. Piepenbrink award for

Outstanding Contributions to Behavioral Health Service.

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Smyth, Bobby P., John Fagan, and Kathy Kernan. "Outcome of Heroin-dependent Adolescents

Presenting for Opiate Substitution Treatment." Journal of Substance Abuse Treatment 42.1

(2012): 35-44. Web.

In the United States, teenagers who are addicted to opiates are much less likely to be

involved with treatment. Only 1% of substance abuse treatments administered to teenagers were

related to opiates. This article follows a study conducted on 100 heroin dependent teenagers with

the average age of 16.6 years old. The results of the study show a clear effect on abstinence and

quality of health. Half of the participants remained in treatment for over a year, but 39%

abstained from heroin. Of the remaining participants, 22% continued treatment with taper plan,

32% dropped out, and 8% were imprisoned. The treatment used for this study included a

combination of methadone and buprenorphine to help control the symptoms of withdrawal.

Despite the proven benefits to treatment, methadone treatments are still controversial, expensive,

and scarce.

This source makes an important distinction about treatment that I want to include in my

paper. These treatments will never have a success rate of 100%. All they can do is help mask the

withdrawals, giving the individual a chance to break the cycle. But it is also up to the individual

to continue of abstain. This study has a success rate of 60% of people who quit or decided to

continue their treatment. Making this health issue well-known to the public while educating

about the resources for help could potentially save many lives.
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This article is published in The Journal of Substance Abuse Treatment. It focuses on the

treatment of substance abuse and addictive disorders, including alcohol, illegal and prescription

drugs, and nicotine. Research submitted to this journal is reviews by the editor-in-chief, Dr.

Hannah K. Knudsen. Dr. Knudsen is an associate professor at the University of Kentucky, who

leads research projects on substance abuse. For one of these studies, she served as the Principle

Investigator of a study on the impact of health reform on buprenorphine treatment for the Nation

Institute of Drug Abuse.

Bell, James. "The Global Diversion of Pharmaceutical Drugs." Addiction 105.9 (2010): 1531-

537. Web.

This article reveals the process of diversion of pharmaceutical opiates. Diversion in this

article refers to when the prescribed medication for one person is being given to someone else,

injecting medications designed to be taken orally, and stockpiling prescriptions meant to be taken

daily. These behaviors have a cyclical nature with methadone treatments, prescription pain

medication and heroin epidemics. When a heroin epidemic occurs, public interest and funding

for methadone treatments goes up. Some people who are addiction become cured. But for others

diversion may occur with some of these medications, and the cycle continues. Supervision with

on-site dosing and increased regulations on who should be able to receive take-away doses has

substantially reduced the presence of methadone in the black market. Unsupervised pain
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medications make up the bulk of diverted medicine and the black market. These medications are

responsible for a whole new generation of people dependent on opiates.

When conducting my inquiry, I wanted to understand the new face that opiate addition

has taken in America. Prescription pain-killer caused an entire new wave of addiction, in the

convenient form of a pill. Loose regulations led to an incredible supply, and demand of the same

magnitude followed. Eventually regulation caught up; pill mills were shut down, doctor writing

absurd prescriptions were questioned, and the mistake was realized. But not before many were

left with a crippling addiction. It was an important step to improve regulation on pain

medication, but treatments like methadone need to take prevalence in the discussion of this

epidemic. They have been proven to have increase the chance of abstinence, and under proper

supervision have a low risk of abuse. I think its important to show in my inquiry that these

treatment are safe, and provide more beneficial results than detrimental side-effects.

Dr. James Bell wrote this article. Dr. Bell graduated in Medicine at Sydney University,

completed a Doctor of Medicine at the University of New South Wales, and was the Director of

the Drug and Alcohol Program for the South Eastern Sydney Area Health Service. In 1999, Dr.

Bell was awarded the Dole-Nyswander Award by the American Association for the Treatment of

Opiate Dependence. He has led clinical trial in the past that focus on the treatment of opiate

dependence and how the delivery affects the results of treatment.

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Merrill, Joseph O. "Policy Progress for Physician Treatment of Opiate Addiction." Journal of

General Internal Medicine 17.5 (2002): 361-68. Web.

This article highlights how public opinion has caused regulatory

policies to separate treatments like methadone clinics from the medical

system. Methadone clinics are stricken with long waiting list, sometimes

months. Strict regulations limit what resources doctors can use to help treat

addiction. In this article, Dr. Merrill suggest several solutions to improve the

quality of care from these programs. Improving the knowledge of physicians

will help them screen, assess, and treat patients with opiate abuse

problems. Higher quality methadone clinics lead to reduced mortality,

overdoses, drug use, criminal behavior, and the spread of infectious

diseases.

For my inquiry, I wanted to see how medical regulation effected the

way doctors can treat opiate addiction. Some doctors feel that the strict

regulations are more detrimental to methadone programs than having

flexibility in the programs. Supervising dosing and strict policies for take-

home doses make it difficult and time-consuming for patients. In addition to

the wait list, this makes it difficult for treatment to be easily accessible. On
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one hand, the strict regulations make diversion more difficult, but

methadone is much less likely to be abuse that medications like OxyContin.

Giving doctors more resources to treat addiction may be more beneficial

than the current system we have.

The author of this article, Dr. Joseph O. Merrill is a University of

Washington associate professor of medicine and is a certified expert in

addiction medicine. He has expertise in the clinic and research aspects of

addition medicine, pain medicine, and HIV medicine. Dr. Merrill has

developed both methadone and buprenorphine treatment programs. In

addition, he mentors physicians in the proper methods of prescribing

opiates for pain management and addiction treatment.